Thyroid Nodules - Treatment Overview

Treatment Overview

Your treatment will depend on how your thyroid nodule affects you. If your thyroid nodule is not cancerous (benign) and is not causing any problems, your doctor will watch the nodule closely before doing anything else. If your thyroid nodule is causing problems, you may need to take medicine or have surgery.

Antithyroid medicine and radioactive iodine can treat benign nodules that are causing your thyroid gland to make too many hormones (hyperthyroidism). For more information on hyperthyroidism, see the topic Hyperthyroidism.

Surgery is usually only necessary if your thyroid nodule is so large that it causes problems with breathing or swallowing or if your nodule is cancerous. After a cancerous nodule is surgically removed, you may need radioactive iodine to destroy any thyroid tissue or cancer cells that are still causing problems. If you need to have your entire thyroid gland removed, you will need to take thyroid hormone medicine for the rest of your life.

For information about thyroid cancer and its treatment, see the topic Thyroid Cancer.

Initial treatment

When you know you have a thyroid nodule, your treatment options include:

• Observation. If your thyroid nodule is not cancerous, your doctor may choose to check it every 6 to 12 months for changes in size. Many noncancerous thyroid nodules stay the same size or shrink without treatment.
• Thyroid biopsy. Your doctor may drain a fluid-filled nodule with a needle. Some fluid-filled nodules will not come back after they are drained, but most do come back.
• Surgery (thyroidectomy). Not all thyroid nodules need surgery. You will need to have surgery to remove part or all of your thyroid gland if:
  • Your nodule is cancerous or suspected to be cancerous.
  • Your nodule is so big that it makes it hard for you to breathe or swallow.
  • You have a fluid-filled nodule that returns after being drained one or two times.
• Thyroid-stimulating hormone (TSH) suppression therapy may be used to shrink a nodule if:
  • Your thyroid nodule is not cancerous, but is large or growing, or if you have a goiter and multiple nodules.
  • Your thyroid nodule is cancerous or suspected to be cancerous, and you are not healthy enough to have surgery.
• Radioactive iodine. Radioactive iodine may be used to destroy thyroid tissue if:
  • Your nodule is noncancerous but is making too much thyroid hormone, causing hyperthyroidism. If you have hyperthyroidism because of your nodule and you are pregnant, it is not a good idea to have radioactive iodine treatment. Your doctor will recommend surgery instead of radioactive iodine.
  • You have several nodules (multinodular goiter) and surgery is not a good idea because of other health problems you have. Radioactive iodine can shrink nodules that cause problems with breathing or swallowing, but your nodules may come back after treatment.

Ongoing treatment

If your doctor is observing your thyroid nodule and there is no change in it, he or she may just continue to watch the nodule. If the nodule changes in size or in other ways, your doctor may do another thyroid biopsy and blood tests for thyroid-stimulating hormone (TSH), or perform surgery (thyroidectomy) to remove the nodule.

If part or all of your thyroid gland needs to be surgically removed because of cancer, radioactive iodine may be used to destroy any thyroid tissue or cancer cells that remain after surgery. Your doctor may also recommend thyroid-stimulating hormone (TSH) suppression therapy to prevent thyroid nodules from coming back.

If you have a thyroid nodule, it is important to:

• Take any thyroid hormone medicine your doctor prescribes at the same time each day and do not miss a dose.
• Follow your doctor's recommendation for getting your blood checked for thyroid level.
• Call your doctor if you have symptoms of hyperthyroidism, such as feeling nervous, having a fast heartbeat, sweating more than usual, and losing weight. Sometimes hyperthyroidism develops from taking thyroid hormone medicine or when a noncancerous nodule starts making too much thyroid hormone.
• Call your doctor if you have symptoms of hypothyroidism, such as feeling tired, feeling cold when others do not, and gaining weight. Hypothyroidism can develop after you are treated with radioactive iodine or you have surgery.
• Schedule regular checkups with your doctor. Even noncancerous nodules need to be looked at by your doctor on a regular basis.

Treatment if the condition gets worse

If your thyroid nodule gets bigger, your doctor may recommend another thyroid biopsy to see whether the nodule has become cancerous. If your nodule has become cancerous or appears to be cancerous, your doctor will probably recommend surgery (thyroidectomy) to remove some or all of your thyroid gland. You may also need thyroid-stimulating hormone (TSH) suppression therapy and/or radioactive iodine.

What To Think About

It is not clear how well thyroid-stimulating hormone suppression therapy works to shrink noncancerous thyroid nodules. If you have a noncancerous nodule, talk to your doctor about whether TSH suppression therapy is right for you.

TSH suppression therapy can raise your risk of heart and bone problems, especially if you have heart disease or osteoporosis. If you have heart disease, this kind of medicine can make chest pain or problems with your heart rhythm worse. It can also raise your chances of heart attack. If you have osteoporosis, TSH suppression therapy can further weaken your bones.

Surgery is the best treatment for cancerous thyroid nodules. If you have a suspicious nodule, you can often wait a while to have surgery because most thyroid cancers grow and spread very slowly. If you choose to delay surgery, your doctor will need to closely watch your nodule.